The Department of Health and Human Services Office of Inspector General (HHS-OIG) maintains an exclusion list of companies and individuals who are not permitted to participate in federal healthcare programs, including indirectly participating by providing goods or services to entities that are billed to federal healthcare programs.

Exclusion is the most severe civil sanction that can be imposed by HHS-OIG and is most commonly due to conviction of a felony or misdemeanor related to a federally funded healthcare program, although individuals and entities can be added to the exclusion list for a variety of reasons. The duration of the exclusion depends on several factors and can range from months to permanent exclusion.

For permissive exclusions, HHS-OIG has discretion over how long the exclusion period lasts. That could be until an individual who has defaulted on a repayment addresses the default, although most permissive exclusions fall in the range of 1 to 3 years. Mandatory exclusions, such as those for misdemeanor and felony convictions, have minimum exclusion periods of 5 or 10 years, although three convictions will result in permanent exclusion.

If an individual is excluded, they are not permitted to work within the healthcare industry for any company that accepts federal funds, which can severely limit work opportunities. Since excluded individuals may still seek employment in the healthcare field, it is vital for employers to regularly check the exclusion list to ensure that new hires can be employed, and also to conduct regular checks of all employed individuals to ensure they can continue to be employed. Employing or continuing to employ an excluded individual risks civil monetary penalties.

HHS-OIG has recently announced new additions to its exclusion list, all of which see the individuals and entities excluded from federally funded healthcare programs for 10 years. In August, HHS-OIG entered into a settlement agreement with Ideal Health Diagnostics, Inc. (Ideal Health) and Svetlana Dizik (Dizik), of Glenview, Illinois, that requires a payment of $227,193.28 in addition to the 10-year exclusion. HHS-OIG alleged that Ideal Health and Dizik solicited and received improper remuneration from Perry Rudich, MD, in exchange for referrals for radiological interpretative services. Ideal Health and Dizik also caused claims to be submitted to Medicare that falsely identified Dr. Rudich as the rendering provider of items and services that he did not perform. Ideal Health and Dizik were not enrolled in Medicare, so they could not bill Medicare for those services themselves or receive payment for those services from Medicare.

In September, HHS-OIG announced 10-year exclusions for Optimum Faith Lab Corp. and its owner, Opal Mullings. Opal Mullings and Optimum had submitted claims for mileage under HCPCS Code P9603 that were improperly inflated, in excess of the actual mileage driven by phlebotomists, not properly prorated, or both. Further, claims were submitted for travel allowance, when only a fingerstick blood draw was performed, when Medicare rules do not permit travel allowance to be claimed for that purpose, and travel allowance was also claimed for laboratory services that were never rendered.

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